New promise for the treatment of T2DM

The European society for the study of Diabetes 2006 just had their meeting. A few things are of interest from this meeting.

Firstly, this is another meeting for the work on diabetes. There must be so much work that they needed another meeting. Almost all the 1st world countries have their fine diabetic societies. There is also the International Diabetic Federation, the American Diabetic Asoociation, the European Diabetic Association, etc, etc. I hope they are all set up with good reasons for advancing patient care.

My worry is that each association or society have their own way of defining terms and levels. We know how confusing diabetic definitions have been, how their target values differ and treatment regimes also differ. We sometimes wish that one godfather will unite all the definitions and make life easier for us especially with regards to patient care.

Secondly, we note the increasing use of the term type 2 Diabetes Mellitus (T2DM) as oppose to NIDDM. There are obvious differences in the two terms. To me T2DM may be more appropriate in adult onset diabetes as this often does not require insulin. NIDDM for good control may sometimes require insulin. Watch and see the diabetic scene change as they embrace this understanding of T2DM. Hopefully this is more than another example of some association just trying to call it differently?

Thirdly the meeting also saw the introduction of a new family of drugs for the treatment of diabetes, the "Gliptins". The gliptins are a new group of agents which are called DPP-4 inhibitors. DPP are enzymes which breakdown glucogonlike peptide-1 (GLP-1). By delaying the degradation of GLP-1, they prolong the action of insulin and delay the release of glucagon. Both of these actions will reduce sugar. It is important that both the compounds studied, vildagliptin (Novartis) and sitagliptin, lowered blood sugar well when used in combination with metformin, with concomitant reduction of HbAic. This was achieved without significant weight gain and also with minimal adverse effects. The results presented certainly make the gliptins very promising. Obviously more studies need be done (I am sure that they will be), but it sure looks good. Of course, I am sure the the gliptins cannot be cheap, except that with two drugs competing, perhaps competition will drive the price down. I am also not sure how to place this new group of drug in our overall unerstanding of management of T2DM. They are not exactly secretogogues, but they are not exactly insulin sensitisers as well. I must seek the advice of my diabetology colleagues. Anyway, any effective and safe agents that can control diabetes well with minimal side-effects, are welcome. The march goes on to stop this epidermic of T2DM.